Osteochondritis Dissecans: Symptoms, Why It Happens, & Long-Term Management
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This article will review the symptoms, causes, management, and prevention of osteochondritis dissecans. Symptoms experienced in the affected joint include difficulty with range of motion, popping or snapping noises, buckling, pain on movement, as well as swelling.
What is osteochondritis dissecans?
The word "osteo" means bone, "chondros" means cartilage, and "itis" means inflammation. "Dissecans" means cutting or dissecting. "Osteochondritis dissecans" means that thin pieces of inflamed, cartilage-covered bone are peeling away from the end of a long bone within a joint. These flakes of bone may come off completely or only partially. Osteochondritis dissecans nearly always occurs in the knee, especially at the far end of the thigh bone (femur). Sometimes it may appear in the ankle or elbow but can happen in any joint. One or more different joints may be affected.
Symptoms experienced in the affected joint include difficulty with range of motion, popping or snapping noises, buckling, pain on movement, as well as swelling. Other potential symptoms include fluid in the joint space and pain on examination.
Treatment is mainly supportive in most cases and will involve rest, improved nutrition, and devices to immobilize the joint. Surgical measures may be taken in more advanced or debilitating cases.
You should visit your primary care physician. Conservative therapy is first considered, such as resting the joint, and physical therapy. Surgery is performed if the conservative treatment fails.
Osteochondritis dissecans symptoms
These usually begin gradually and are first noticed while exercising.
- Difficulty with range of motion: The joint will not flex or straighten as far as it used to and may catch or lock.
- Popping or snapping noises
- Buckling: The joint may buckle or give way when used for support.
- Pain on movement
These may appear within months of the first symptoms and tend to progress quickly. On physical examination, further symptoms will be found.
- Fluid in the joint space
- Pain on examination: Usually in a specific spot within the joint
Osteochondritis dissecans causes
Bone breakdown occurs in osteochondritis dissecans because something is interfering with its blood supply, causing parts of it to die (necrosis). This interference is most likely due to a combination of hereditary traits and one or more additional factors.
- Hereditary traits: These cause the person to be born with a weakness in their bones or cartilage.
- Repetitive strain injury/overuse: Examples include training for a sport or doing hard physical labor
- Interference with blood flow: This can cause damage and death to small spots of bone and cartilage tissue. There are two types of blood flow interference. Ischemia is partial loss of blood flow and avascular necrosis is a complete loss of blood flow. Once the bone tissue is damaged enough, or dead, it will separate from the end of the main bone in flakes or small pieces.
- A growth spurt: This can affect a young person since rapid growth stresses the bone somewhat.
- Dietary deficiencies or mineral imbalances: If the nutrients needed for proper bone growth are missing, this will result in weakened bone.
Who is most often affected
The following groups are more likely to be affected by osteochondritis dissecans.
- Young people from the ages of 12 to 19: Especially those who are playing high-impact sports such as soccer, tennis, gymnastics, and weightlifting, or doing strenuous physical work such as farm labor.
- Anyone with a family history of osteochondritis dissecans: It is largely an inherited trait and is often seen with small/short stature or osteoarthritis that appears early in life.
- Anyone with sickle cell disease: This illness can block the blood supply to some parts of the bone.
Related and similar conditions
There are several related or similar conditions not to be confused with osteochondritis dissecans. These include:
- Osteochondrosis: This is a general term for an abnormality of the bone and cartilage. Osteochondritis dissecans is a type of osteochondrosis but has its own particular characteristics.
- Joint fracture: This is sometimes believed to be the cause for pain within the joint, as the symptoms are similar. However, a fracture is nearly always the result of an acute injury with immediate pain and loss of use. Osteochondritis dissecans begins more gradually with a buildup of symptoms.
- Sickle cell: This may be seen with osteochondritis dissecans due to the interference with the blood supply that sickle cell can cause.
Treatment options and prevention
Osteochondritis dissecans is considered a long-term illness that may be cured, or at least well managed, with long-term therapy.
Rest can benefit people of all ages experiencing this condition.
- Younger people: In younger people (those under age 18) new bone and cartilage are still growing. Therefore, simply stopping the heavy sports activity or physical work can allow new bone growth to heal the damage.
- Older people: Older people can benefit from rest so that the damage does not progress to degenerative arthritis.
Supportive measures may involve improved nutrition as well as assistive devices.
- Improved nutrition: The proper amounts and balances of calcium, phosphorus, and protein are necessary for bone growth and repair at any age. A medical provider can refer you to a nutritionist for help with planning an appropriate diet.
- Mobility support: Taking the strain off of the damaged bones for a while by using braces, a cane, crutches, splints, or casts can allow faster healing.
Surgery for more advanced or debilitating cases may be recommended.
- Cases that may need surgery: Surgery will be recommended when other measures do not help, especially in people over age 18. Surgery is also needed for a partially separated piece of bone or if the area of damage at the end of the joint is larger than one centimeter. This also applies if a piece of bone has completely separated and is "floating" within the joint space.
- Types of surgery: Different types of surgical repair are available, such as drilling into the damaged area at the end of the bone. This can encourage the growth of new blood vessels and better blood supply. Pins and screws can be used to hold the partially separated bone in place, or new pieces of living bone and cartilage can be grafted into the damaged area.
It may be helpful to keep the following in mind as you recover from supportive care or surgery.
- Physical therapy: Your medical provider can give you a referral to the right physical therapist.
- Avoid overuse: The most important thing is to rest until you are cleared to resume strenuous physical activity.
- After a few months of supportive care: Children and teenagers will usually see improvement in pain and swelling and will be ready for normal activity after about three to four months of supportive care.
- After surgery: For the first six weeks, crutches will be needed. After six weeks, physical therapy will begin. This lasts for two to four months. After four to five months, a return to normal activity is usually possible.
This condition can likely be prevented by adhering to the following recommendations for a healthy lifestyle.
- Diet: Provide a high-protein diet with supplemental vitamins and minerals for all children and teenagers.
- Exercise: Encourage normal amounts of play and exercise but limit heavy sports training or hard physical work for children and teenagers, especially without professional support.
- Medical testing: This can be done to look for sickle cell disease, especially if you were not tested for it at birth.
If young adults begin experiencing symptoms
The condition can be more damaging once the person has finished growing — after about ages 18 to 21 — because the bones are no longer forming new tissue at the same rate.
If younger children and teenagers are experiencing symptoms
In younger children and teenagers, whose bones are still growing, the new bone and cartilage growth may be enough to replace any damaged pieces. The condition may heal on its own if the overuse is stopped.
Questions your doctor may ask to diagnose
- Is your knee pain constant or come-and-go?
- Is your knee pain getting better or worse?
- How severe is your knee pain?
- How long has your knee pain been going on?
- How would you explain the cause of your knee pain?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
- Osteochondritis Dissecans. American Academy of Orthopaedic Surgeons: OrthoInfo. Reviewed March 2012. OrthoInfo Link
- Osteochondritis dissecans. Genetic and Rare Disease Information Center. Updated Feb. 6, 2015. GARD Link
- Osteochondritis Dissecans: Symptoms and Causes. Boston Children’s Hospital. Boston Children’s Link
- Osteochondritis Dissecans. Johns Hopkins Medicine. Johns Hopkins Medicine Link
- Pascual-Garrido C, McNickle AG, Cole BJ. Surgical treatment options for osteochondritis dissecans of the knee. Sports Health. 2009;1(4):326–334. NCBI Link